Recently in Hospitals Category

The adult social care sector in England suffered a double blow in yesterday's Queen's Speech: there will be no legislation to reform social care in 2012-13, as had been expected, merely a draft bill; and the Department of Health's notes on the draft bill contained not one mention of to create a sustainable funding system, the sector's highest priority.

New research from the Nuffield Trust finds care home residents are less likely to end up in hospital than people with large home care packages. In this guest post, trust head of research Martin Bardsley asks why this might be?

Within the research group of the Nuffield Trust we have a number of studies that use the anonymised linkage of health and social care records. The results of one study are due to be published in Journal of Health Services Research and Policy soon but they have left us with a puzzle.

So we found that from a population of older people (aged 75+) in four local authority areas, 14% used some form of local authority social care over a one-year period, and 71% of that group also used hospital care in that year. Hardly newsworthy - social care users go to hospital - though it is perhaps more surprising that studies of this type have not been undertaken much before.  

A lot of our work looks at how to avoid people having emergency hospital care - on the basis that emergency admissions are not very pleasant for the patients, can be costly to the NHS and, in an ideal world, we should be finding ways to prevent health problems turning into crises.  

So we looked at how frequently social care users went to hospital. We found that those in care homes tended to use less hospital care than people receiving intensive home care. The people in care homes had fewer emergency and elective admissions. They also had fewer outpatient attendances than people not receiving any local authority funded social care.

This wasn't a result we particularly wanted to observe - like everybody else, we like the idea of independent older people being able to live in their own homes.  So for the past few months I have asked people who know more than me what they think of this observation. I should note that our carefully crafted empirical observation was no great surprise for some people, but how should we interpret it?  

Is it a good thing? Is it that care homes are doing all the right things to avoid health crises?  Do they provide an environment that manages health problems with more prevention and support than care services in somebody's home?

Or, is it a bad thing? Is it that for some people care homes are not helping get the access to hospital care that they should have?  Are we seeing an example of discrimination against some older people living in care homes?

People have views on these but I have to admit I just don't know. It's probably a bit of both - it usually is. Maybe what's important is to find out the things that prevent the need for hospital care rather than where they are delivered.

For me the significance of the observation is twofold.  Firstly, that reduction in social care budgets and access to care homes may put a positive pressure on hospitals.

Secondly, that we ought to be looking to use these data to understand something more about what constitutes good-quality social care, and see if we can use information about the management of health problems, to help spot the difference between good and bad social care.

This piece has also been published on the Nuffield Trust website.

Sorry to be late on this but health and social care staff are being urged to sign up to a "dignity code" governing the treatment of older people by none other than care services minister Paul Burstow and Labour shadow Liz Kendall, among others.

The code is a response to the string of bad news stories around the indignities faced by older people in some hospitals and care homes.

Drawn up by the National Pensioners' Convention its precepts are core social work and social care values. For example:

• Respect for individuals to make up their own minds, and for their personal wishes as expressed in 'living wills', for implementation when they can no longer express themselves clearly.
• Respect for an individual's habits, values, particular cultural background and any needs, linguistic or otherwise.
• The use of formal spoken terms of address, unless invited to do otherwise.
• Comfort, consideration, inclusion, participation, stimulation and a sense of purpose in all aspects of care.

The code has been backed by regulators (the General Social Care Council and Care Quality Commission), charities (Age UK and Action on Elder Abuse) and workforce representatives (Unison and the Royal College of Nursing) and signatories want to see it displayed "in every GP surgery, social services department, hospital ward and nursing home".

It would be easy to be churlish and point to the co-existence of undignified care with pre-existing codes of practice for care staff, including those that carry regulatory requirements; however, it can do no wrong and may hopefully bring about some good as a statement of minimum expectations of services.

(Image on Flickr from hweiling)

Bed-blocking - or delayed discharges of care - is on the rise again with the inevitable blame game between health and social care likely to kick off before long.

Deprivation of Liberty Safeguards (Dols) watchers (you know who you are) will be well aware that the number of applications for the safeguards from has been well below expected levels, with large variations between areas.

The implications are that people are being deprived of their liberty in care homes or hospitals without the protection that the Dols bring, and that this problem is particularly acute in certain areas. So how do you turn this situation around?

I was chatting to Dols expert Toby Williamson, of the Mental Health Foundation, the other day, who has a suggestion: the creation of an audit tool for care homes and hospitals to use to test whether residents or patients are being deprived of their liberty.

This would be tested on a sample of people in each area, ideally, so that local authorities and primary care trusts - who assess Dols applications - can gain an understanding of the extent to which people in their area are not being protected by the safeguards.

They can then work with care homes and hospitals to raise awareness of when they need to apply for a safeguard and provide training for staff where necessary.

It would all be done confidentially and without prejudice, so that care homes and hospitals wouldn't feel that this was a stick to beat them with.

It sounds a good plan but Williamson stresses that we need someone to design and implement such a tool. The Mental Health Foundation was considering it but could not source funding to do so.

He suggests that it is not a job for the Department of Health as this could appear heavy-handed. So do we have any other candidates? Maybe it's something for council or NHS bodies - the Association of Directors of Adult Social Services and the NHS Confederation, notably - to do in tandem with care provider organisations such as the English Community Care Association.

It has been a good week for the Care Quality Commission. On Tuesday it released figures showing inspections of adult social care services grew by a third over the last three months.

Today, it announced that it is partnering with Age UK, Challenging Behaviour Foundation and Choice Support to provide experts to help with its work. More partners are to follow.

It'll be a welcome move from those who have voiced concern over lack of expertise at the regulator following the Winterbourne View abuse scandal. Several people have told me that they believe one of the reasons the CQC was not quick to act when a whistleblower told it about the abuse at the hospital, was because it no longer has learning disability experts on the books, who might have kept staff alert to the dangers of learning disability hospitals.

Perhaps the most shocking thing about the figures, uncovered by Community Care today, showing that one in five people with learning disabilities in specialist hospitals have been there five years or more is that they are so predictable.

The fact that people with learning disabilities spend years on end in specialist hospitals has become the norm.

The last Count Me In census of learning disability inpatients, which was published this April, but conducted last March, showed an even higher percentage (31%) of people staying five years or more.

Either figure, given this form of care as a long term model has been discredited since 1993 by the likes of Jim Mansell, is unacceptable.

Community Care didn't report the story in those terms in April (we went with the mental health and race angle), neither did the Guardian, which is the most sympathetic mainstream media outlet (it also ran with the race angle), it wasn't even news. It was a long term trend once more confirmed way-down in a big statistical report.

Yet, when we collected these latest figures and put them to a variety of experts and politicians they were consistently appalled. One commentator laughed, not because it was funny, but because it was so exasperatingly familiar.

That is the real scandal. And one which must stop. Hopefully, in the light of the Winterbourne View case, these numbers will begin to prompt greater commitment and action from those able to change it.

The big story of the weekend seemed to be all the resignations of journalists and police over the New of the World scandal, which is why this particular resignation may have sneaked under your radar.

Paul Brosnan, chair of Castlebeck, resigned over the weekend following the expose of alleged abuse at Winterbourne View hospital by BBC Panorama.

The company's statement said: "Paul Brosnan has told the board that he believes the company needs a chairman with relevant health and social care experience at this time."

The Observe reports, that Brosnan is a former banker. It's difficult to imagine how that would qualify you to run a care business.

Also, why was it not necessary to have someone with a bit of knowledge of social care or learning disability in the top job when the Company was not making headlines for all the wrong reasons?

This news broke just a day before the CQC published its report on Winterbourne View, which shows that the hospital had inadequate vetting of the qualifications of staff. Well, it would seem that trend runs all the way up to the top leadership.